Reasons for nondisclosure of suicide ideation or attempts among adolescents from ethnoracially and socioeconomically diverse backgrounds with a recent suicidal episode

BACKGROUND: Adolescent emergency department visits for suicide ideation or attempts are increasing, particularly among youth of color. Many adolescents do not disclose their suicidal thoughts to anyone prior to presentation, and it is unclear why. The present study examined adolescents' reasons for not disclosing their suicide ideation or attempts prior to presenting for clinical care. METHODS: Adolescents, ages 12-19 years, who presented to emergency departments in New York City with recent suicide ideation or a suicide attempt were interviewed about the circumstances surrounding their recent ideation or attempt. Those who reported not disclosing their suicide ideation to others (N = 70; 79% Hispanic/Latine; 77% female) - 23 of whom presented with suicide ideation, 47 with a suicide attempt - were asked about their reasons for not disclosing their ideation in a semi-structured interview. RESULTS: Through thematic analysis, we found eight reasons that adolescents gave for not disclosing their suicide ideation. Four reasons were related to others' reactions, including perceived unavailability of support, negative impacts of their disclosure on others, anticipating others' negative judgments, and fear of punitive consequences (e.g., institutionalized responses). Four reasons were related to internal factors, including their wish to die, desire for privacy and nondisclosure, anticipating their own emotional distress, and believing their suicide ideation did not warrant disclosure. CONCLUSIONS: These findings highlight the importance of addressing both interpersonal and intrapersonal barriers to suicide-related disclosure among adolescents. Enhancing provider communication strategies and developing culturally responsive screening tools and interventions may help identify at-risk adolescents who might otherwise remain undetected.